HomeMy WebLinkAboutWell New 54 Miller Road CONSUMER PROTECTION ,
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
aPR•e REV.8•79 DEPARTMENT OF CONSUMER PROTECTION 69860
WELL DRILLING PERMIT
20 GRAND STREET,HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(rO N) (Steel) (Lot Number) DATE
S. Windsor 54 Miller Rd.
OWNER OF WELL
3 INDIVIDUAL � BUILDER � OTHER(Specify)
OWNER'S ADDRESS
Sebastiano Matarazzo, 54 Miller Rd., S. Windsor CT 06074
PROPOSED BUSINESS TEST Est.No.of
11 DOMESTIC ESTABLISHMENT 11 FARM El WELL People being
USE OF served.
PUBLIC AIR OTHER
WELL SUPPLY INDUSTRIAL CONDITIONING ❑ (Specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
Location of lot to at least two roads Well location on lot and to house(if present)
-5 c PT/G
G . (0Indicate North
PRpaosE13
441;
OR1v
-ER 9D
Approximate number of feet from well to
nearest source of possible contamination:
The undersigned is aware that upon completion of the well, a "Well Completion Report" contoining construction details and information required under Section
25.131 of the 1969 Supplement to the General Statutes must be sent'to the owner, the Board and the Water Resources Commission on the form provided by the
Board.This permit is not valid until all information is filled in and it has been•counier-signed by the Director of Health or his agent. .
1
APPLICIWT rej APPLICANT'S ADDRESS / REGISTRATIONNO.
// �i r� 100
t
.001 BY(roue Heck O or tut) t DATE
aAPPROVED REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE of CONNECTICUT
CPR-9 REV. e-79 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
20 GRAND STREET
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME _. :AJuf:i.,
OWNER B.ASSTMO IUTAR.t�.'ZZO 1,IL -�e� �y9-T�
• ,s.I: ,#....tS:rLF. l4.tJ r 1:J• V11 CT.
LOCATION (No. & Street) (Town) (Lot Number)
OF WELL 54 MILIXR RD♦ tom?. E INDSO
BUSINESS
PROPOSED DOMESTIC ESTABLISHMENT El FARM TEST WELL
USE OF
WELL OTHERPUBLIC AIR
SUPPLY INDUSTRIAL CONDITIONING (Specify)
COMPRESSEDDRILLING OTHER
EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS t tt THREADED WELDED YES NO 6D YES NO
YIELD 3 'P HOURS YIELD(G.P.M.)
TEST BAILED PUMPED COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) D
LEVEL epth of Completed Well
`� 4 in feet below Land surface:
105
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM(feet) TO(feet
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET-TO FEET two permanent landmarks.
3 24 Cl.
2 10 . Red Rock
f
LF6
f
If yield was tested at different depths during drilling, list below -
FEET GALLONS PER MINUTE
t (F Q V,
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEL D ER(Signature}
KEPT. OF FMfIRONMFNTAI minTrrTirw MIATCD Deem ine,,,